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Home My WebLink About0194 DONEGAL CIRCLE - Health (2) l(�9 / 03-7 � l'0 v� I\ I� t C I �' I No....l.. .�.._ FEB THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apphration for Bi-npoott1 Workii Tonotrnrtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ' an Individual Sewage Disposal System at: - ........ c..! ••...............•---•-----..._...•--•------•---•------------•---•---•••••. ----"•-'--•••-'-"•'---•-------•-----•-••-.....-------------•...-•-----•---•............--•-••--- I tl-Addre s or,-Address or t No. .... t..-'^ 6---•-••...................................... ................. C�-�-U�` ................................................ Installer Address Type of Building Size Lot............................Sq. feet ►. Dwelling— No. of Bedrooms................____________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ________________ ________________ _ W Design Flow........ ........................gallons per person per day. Total daily flow..._�.?_U........................gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width---------------- Diameter__.---...._____- Depth................ x Disposal Trench-No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------I............ Diameter.._... Depth below inlet..... ........ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY.......................................................................... Date........................................ ,.a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..................... f14 Test Pit No. 2................minutes per inch Depth of Test Pit__..____--..____-_-- Depth to ground water........................ 94 -----------------------•----'-"------------'•-----------'-'-----•-------------•---.........._..........-----------------•-•••--------............".-•••-•" 0 Description of Soil........................................................................................................................................................................ x U ---•---•'-------------------•'•----------....-----'••--"-----'------------------------•-••--••-'--------•-----••••--'-------•-----------------•-•-•--'•--•------------------------•.......------....... -------------------------------------------------------------------------------------------------------------- ---------- U Nature of Repairs or Alterations—Answer when applicable.._. .._. ?� ...................... .....------ c � �c _ ll�vU c� R _" -----'•---------------•-•-----------.............._......--'------_.... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Comp bee issu tby-t d d -alth ,- t �.7 ............... ... .................................. .... .. .. -�. Date Application Approved BY � - ------------------------------------------------... ..... =-lei-` Application Disapproved for the following rearonf- ------------------------------------------------------------------------------------------------------------------------------------ ...................................................................................................................................................... ....... Permit No. ....... .........-... �}�� .. ........... Issued ...- ---- - -- -- -. ...............-....e...... Date ——————————.————.— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiuu for Uinpuual Work.6 Towitrurtiuu Permit Application is hereby made for a Permit to Construct ( ) or Repair ((-- an Individual Sewage Disposal System at: • •-•••••-•-•--•----- •••-••••••----•-----------••-•---•-•--•------ • •-•••••-•••--•------•---•-----...--•-••••- Locat on-Address t or °t No. • -----•---•---•---•• ................................................... wn A rs....ff�_P--------------------------- . Installer Address UType of Building Size Lot............................Sq. feet r., Dwelling—No. of Bedrooms.__-3__________________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons......._-------------------- Showers ( ) — Cafeteria ( ) dOther fixtures .--•-••--------- --------------- W Design Flow......___ --•---_--_.--••--•-•_-__gallons per person per day. Total daily flow.... .0........................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area______-_•_--_.._•---sq. ft. t / > Seepage Pit No_______ _____________ Diameter._.___/ ..___.._ Depth below inlet_._._._........ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) `" Percolation Test Results Performed bY------- ------•-------••-••-••-••••....--------•-•----•--•----•......••••. Date...................................... aTest Pit No. I________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ GZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ----•-----------------------------------•-•-•-•••--•••-••••----•--••••-•-•-•--•-••---•-••-••••••............................................................. 0 Description of Soil........................................................................................................................................................................ x V ....•••••---•---•-•----••-•-••-••-.._...••••-•••••••••-•••-•---•--••-------••-•---•-••••••-•-••----•••••-•••••---••••-••••••----••-••-•••-•-•---••-•----•----•••---••••••••••-•••----•-••--••-••--•--•-- W ------------------------------------------------------------------------------------------------------------- r--------------•- -•-•---•--•-••- UNature of Repairs or Alterations—Answer when applicable.---�f!-.S --1------- . .....! r' ?...... •- �`-'S J•-•�nao-SAP Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Ca`ia-ne-e-4as 6 eI issu ' -y-t-1 b and health. Signed ............ --- --------- ---- - ............... ........................................ Dace � 1 ............ . ...._......... .Application Approved BY ..... � �..-_.... ...............- Date . Application Disapproved for the following reasonr: ............. . . .............. ..........................................------------------------------- --....................-------------1\---------------------------.......--------------------------------------------------------------...............----------------------------------------------- ---------------------------------------- DatePermit No. - - �3 ................. Issued .................................................... ----- ---------- ------------------- t Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE LLTTertifirate of dilomplii nce THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (L-4/11 by..---------...................-------------------------- ----- ------_...........-----._......-------------------------------------------- -------------------------------------------- r n Iallet � 1 1------ .... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described'in the application for Disposal Works Construction Permit No. ------- .. .-.... ... dated ........._. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISF CTORY. � G DATE - �^-f- -----------------------_.... Inspector ...�� ---------- ..------------------------------�- '-' -'�.-��:.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.... FEE.:.•.-::,•:.)��- %Vaoal Vorkii Tuuutrurtiuu Permit Permission is hereby granted................. _(! /I-P Ld.)A v-------_-------------------------- ------------- ............................. to Construct ( ) or Repair (L'_a� Individual Sewage Disposal System atNo.......... -••••••--•-••••-•••• /`"/ Street /� t as shown on the application for Disposal Works Construction Permit No. :. ._Jr.5 Dated...... r_l. . ........ ................ )-----------------------------------------•-••-- ��yy C� Board of Health DATE.................L -___J---��---_-`�•_.0 FORM 36508 HOBBS 6 WARREN.INC..PUBLISH/ERS